Patient-reported outcomes for patients with locally advanced or metastatic urothelial carcinoma under pembrolizumab: A prospective multicenter observational study.
Authors: Soufyan Annakib, Yona Dibert Bekoy, Thierry Chevallier, Frédéric Fiteni, Nadine Houede
Journal: Journal of Clinical Oncology (2023)

490 Background: Evaluation of Patient-Reported Outcomes (PROs) is a major element used by health authorities for treatment approval. Pembrolizumab is a validated second-line treatment for locally advanced or metastatic urothelial carcinoma (la/mUC). In this real-life study, we aimed to describe la/mUC patients’ health-related quality of life (HRQoL) and patient/clinician-reported symptoms before and after pembrolizumab initiation. Here, we present interim results to assess clinical relevance for further analysis. Methods: A multicenter prospective French study was designed. PROs were assessed before pembrolizumab initiation (baseline) and at each treatment visit for seven timepoints. We report the analyses of the first three timepoints. HRQoL was measured using the European Organization for Research and Treatment of Cancer Quality-of-life Questionnaire-Core 30 (EORTC QLQ-C30) and the EuroQoL 5-dimensions 5-level (EQ-5D-5L) questionnaires. PRO-Common Terminology Criteria for Adverse Events (PRO-CTCAE) and CTCAE were assessed for 20 selected symptoms by both patients and clinicians in a blinded manner. Agreement in severity between clinicians and patients for all grade ≥3 symptoms was calculated with Cohen's kappa coefficient. Results: 39 patients were analyzed. Baseline completion rates were 69%, 62%, 59% and 12.8% for EORTC QLQ-C30, EQ-5D-5L, PRO-CTCAE and CTCAE respectively. Baseline median EORTC QLQ-C30 global health and summary scores were respectively 66.7 [interquartile range; 54.2, 79.2] and 83.6 [73.9, 94]. Improvement in EORTC QLQ-C30 global health median score to cycle 2 was observed in 33.3% patients, while the remaining patients experienced worsening score. Baseline mean EQ-5D-5L Visual Analog Scale score was 65.3 (Standard deviation (SD), 21.6), and 63.5 (SD, 16.1) at cycle 2. EQ-5D-5L domains scored level 1 decreased between baseline and cycle 2 for mobility (16 vs 14 patients) (p=0.0143), self-care (16 vs 14 patients) (p=0.0048), and usual activities (15 vs 14 patients) (p=0.015). Of 17 severity assessed symptoms, the Cohen's kappa coefficient was fair ĸ=0.35 (95% confidence interval (CI) [-0.08; 0.78]) for general pain, and bad ĸ=-0.063 (95%CI [-0.17; -0, 04]) for abdominal pain. In terms of symptom frequency, patients reported 19 symptoms at each visit. However, clinicians reported 13 and 14 symptoms respectively at baseline and cycle 2. Conclusions: HRQoL for la/mUC patients after first pembrolizumab infusion showed contradictory results with previous reports with a trend for HRQoL degradation after one treatment cycle. Comparative symptom severity assessment showed poor agreement between patients and clinicians. Clinicians graded symptoms less severely than patients. The final analysis will provide more complete data with longitudinal analysis to strengthen our preliminary conclusions. Clinical trial information: NCT03584659 .